CDC Update: Whats New in Data

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CDC Update Whats New in Data?

• Julie Bolen, PhD, MPH
• and Jennifer M. Hootman, PhD
• CDC Arthritis Program

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What help do states want with arthritis data from
the CDC Arthritis Program? Follow-up from the
2008 Arthritis Grantee Meeting.

• Detailed description is in your notebook.
• data are needed to help build partnerships at
  state and local level
• and to help capture media attention about the
  burden of arthritis and interventions to manage
  arthritis symptoms.

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What help do states want with arthritis data from
the CDC Arthritis Program? Follow-up from the
2008 Arthritis Grantee Meeting.

• Many requested items are covered in this
  presentation
• More information on Quality of Life (QOL)
• More information on co-morbidities
• More local data
• New/expanded estimates for work limitation
• Expanded data summary sheets
• Updated data on disparities

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Whats new or changing?

• Chronic Disease Indicators
• State and selected local estimates
• New 2009 BRFSS data
• New BRFSS Physical Activity Questions
• HP 2010/2020 updates
• ACR/ARHP Presentations
• MMWRs on Disability, co-morbidity, disparities
• Cost data update
• Special data collection for anxiety/depression

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Chronic Disease Indicators

• 8 Arthritis Indicators for States (2007 data)
• DRDX
• Limitations
• General Health Status
• Physical Activity
• Arthritis / Obese
• Arthritis / Diabetes
• Arthritis / Heart Disease
• Ever taken a class?
• Similar estimates for 31 local areas (largest
  counties/health departments) added in 2009.

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Sub-state Estimates

• 2007 Arthritis Prevalence
• http//apps.nccd.cdc.gov/gisbrfss/select_question.
  aspx

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BRFSS Plan for 2009

• Drop 2 on CJS, see DR for SX
• Keep DRDX, Limited
• Add 3 new questions

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BRFSS Arthritis Data

• Collected in odd numbers years
• 5 core questions (burden)
• 5 optional module questions (mgmt)
• You should have 5 standard tables for 2007
• Single page summary data for 2007
• If you dont have these please e-mail me

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Dropped questions 2009

• The next questions refer to your joints. Please
  do NOT include the back or neck. DURING THE PAST
  30 DAYS, have you had any symptoms of pain,
  aching, or stiffness in or around a joint?
• Did your joint symptoms FIRST begin more than 3
  months ago?
• Have you EVER seen a doctor or other health
  professional for these joint symptoms?

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2009 BRFSS Questions

• Existing BRFSS questions for 2009
• DrDx ever told by Dr have A, RA, G, L, or F?
• Limited activities due to arthritis?
• New BRFSS questions for 2009
• Arthritis affect work?
• Arthritis interfere with social activities?
• Joint Pain (0-10) past 30 days?

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• In this next question we are referring to work
  for pay. Do arthritis or joint symptoms now
  affect whether you work, the type of work you do,
  or the amount of work you do?
• On 2003 BRFSS
• On NHIS in 2002, 2003, 2006, 2009
• Help promote worksite programs
• Reducing impact on work is HP2010 goal

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• During the past 30 days, to what extent has your
  arthritis or joint symptoms interfered with your
  normal social activities, such as going shopping,
  to the movies, or to religious or social
  gatherings? (READ 1-3)
• 1) A lot
• 2) A little or
• 3) Not at all

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• Please think about the past 30 days, keeping in
  mind all of your joint pain or aching and whether
  or not you have taken medication. DURING THE PAST
  30 DAYS, how bad was your joint pain ON AVERAGE?
  Please answer on a scale of 0 to 10 where 0 is no
  pain or aching and 10 is pain or aching as bad as
  it can be.
• On NHIS in 2002, 2003, 2006, 2009
• Pain reduction is HP2010 goal

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Rationale for changes

• PWA get serious about intervention when arthritis
  interferes with valued activities
• New questions should help states identify which
  groups may be more receptive to EB interventions

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2009 BRFSS Expanded HR-QOL

• New standard table HR-QOL by age, sex, race and
  education
• fair/poor health
• 14 mentally unhealthy days
• 14 physically unhealthy days
• 14 limited activity days (not specific to
  arthritis)
• Expanded 1 page summary sheet will include more
  data for new questions and more on co-morbidities
  and quality of life

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New HR-QOL Standard Table

• WEIGHTED ADULTS WITH
  WEIGHTED ADULTS WITH
• 
  DOCTOR-DIAGNOSED ARTHRITIS WHO
  DOCTOR-DIAGNOSED ARTHRITIS WHO
• REPORT
  FAIR OR POOR HEALTH REPORT 14
  PHYSICALLY UNHEALTHY DAYS
• 
  _________________________________
  _________________________________
• ADULTS
  RATES 95CI ADULTS RATES
  95CI
• (1000s)
  (1000s)
• CHARACTERISTIC
  _________________________________
  _________________________________
• TOTAL 18148
  30.3 (29.8 - 30.8) 13434 23.0
  (22.6 - 23.4)
• 
  _________________________________
  _________________________________
• 
  
• AGE GROUP(YEARS)
• 18-44 2987
  24.5 (23.2 - 25.8) 2411 20.0
  (18.9 - 21.2)
• 45-64 8018
  30.2 (29.5 - 30.9) 6341 24.3
  (23.7 - 25.0)
• 65 7052
  33.8 (33.1 - 34.5) 4617 23.1
  (22.5 - 23.7)
• SEX
• FEMALE 10953
  31.0 (30.4 - 31.6) 8272 24.2
  (23.6 - 24.7)
• MALE 7195
  29.3 (28.4 - 30.1) 5162 21.4
  (20.7 - 22.1)
• 
  

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BRFSS Physical Activity Module Changes for 2011
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Rationale

• New PA Guidelines released Oct.2008
• Aerobic requirement (minutes/week)
• Strengthening requirement (2x/week)
• DNPAO reviewed surveillance needs for reporting
  new PAG
• Current BRFSS module (2001-current)
• Does not have strengthening question
• Likely overestimates PA by including many types
  of activity (leisure, household, and
  transportation)

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Proposal Rotating Core

• Replace existing 6-question module with PA module
  used 1984-2000
• Asked about leisure-time only, consistent with
  new PAG (PA above usual activities)
• Can assess individual activities (e.g. walking)
• Replace occupational PA question (currently
  optional module) with strengthening question

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Proposed 2011 Questions

• During the past month, did you participate in any
  physical activities or exercises such as running,
  calisthenics, golf, gardening, or walking for
  exercise? asked 2x current EXERANY tracking
  question
• What type?
• How often?
• How long?
• During the past month, how many times per week or
  per month did you do physical activities or
  exercises specifically designed to STRENGTHEN
  your muscles such as lifting weights or doing
  calisthenics? (Include all such activities even
  if you have mentioned them before.)

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Pros

• Total number of questions remains the same (n
  7)
• Start 2011 after BRFSS proposed design change
  in 2010 (re-weighting)
• Muscle strengthening questions, important for
• Monitoring PAG
• Special populations (diabetes, arthritis, older
  adults)
• Measuring leisure-time PA only, states can
  directly monitor HP2010 objectives

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Cons

• Data analysis may be more complex, but
  programming, calculated variables, and technical
  assistance will be provided to states by CDC
• Difficulty comparing estimates pre-2000 (same
  questions but different BRFSS weights) and to
  2001-2010 (different questions)
• May not be directly comparable to NHIS and NHANES
  but each will provide unique data on PA

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Implications for Arthritis Programs

• CDC Arthritis Program supportive of proposal
• Monitor PWA meeting new PAG
• State-level HP 2010 objective tracking
• Capture type of activity (walking, cycling, etc.)
• CDC will update standard table with new estimates
  using DNPAO programming
• Will help states with interpretation of standard
  table data

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Co-morbidity MMWRs and Disability

• Arthritis as a Potential Barrier to Physical
  Activity Among Adults With Heart Disease ---
  United States, 2005 and 2007. Feb. 27, 2009 MMWR
• Prevalence and Most Common Causes of Disability
  Among Adults --- United States, 2005. May 1, 2009
  MMWR

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Racial Disparities MMWR

• Racial disparities in total knee replacement
  among Medicare enrollees United States
  2000-2006. MMWR 200958133-138.

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Award Winning Presentations

• Louise Murphy was nominated for the Shepard
  Award, CDCs highest scientific honor, for her
  paper Lifetime risk of symptomatic knee
  osteoarthritis.
• Louise also won 2 awards for consequential
  epidemiology at 2009 Chronic Disease Conference.
• Co-morbidities and Chronic Disease Risk Factors
  are Very Common among People with Arthritis
• Co-morbidity Status of People with Arthritis
  Sways their Self-Management Education Program
• Two posters recognized as Most Notable work at
  the American College of Rheumatology scientific
  meeting in October, 2008.
• Cisternas Murphy - Trends in medical care
  expenditures for persons with Arthritis and Other
  Rheumatic Conditions 1997-2005
• Jennie Hootman - Healthy Days and fair/poor
  health among US adults with and without
  arthritis, 50 states and DC, BRFSS, 2005

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Presentations for American College of
Rheumatology/ Association of Rheumatology Health
Professionals Annual Meeting

• Impact of arthritis on work
• Impact of arthritis on quality of life
• Arthritis and co-morbid conditions
• Engaging the media to promote Self Mgmt
• Burden and impact of arthritis by race/eth

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HP 2010/2020 Update Arthritis, Osteoporosis, and
Chronic Back Conditions Workgroup

• Arthritis-related Objectives
• 2-1. Reduce joint pain among adults with
  arthritis.
• 2-2. Reduce limitation in activity due to
  arthritis or joint symptoms.
• 2-3 Reduce difficulty in performing two or more
  personal care activities, thereby preserving
  independence.
• 2-4. Increase health care provider counseling
• For weight reduction among overweight and obese
  persons.
• For physical activity or exercise.
• 2-5 Reduce the impact of arthritis on employment
  in the working-aged population.
• 2-5a. Reduce unemployment rate among adults with
  arthritis.
• 2-5b. Reduce proportion with arthritis who are
  limited in their ability to work for pay due to
  arthritis.
• 2-6. Eliminate racial disparities in the rate of
  total knee replacements (age 65).
• 2-7 Increase the proportion of adults with
  chronic joint symptoms who have seen a health
  care provider for their symptoms.
• 2-8 Increase the proportion of adults with
  arthritis who have had effective, evidence-based
  arthritis education.
• Mixed (modest at best) progress toward HP
  Arthritis Objectives 2000-2006

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4 New HP 2020 objectives - Proposed

• Reduce the proportion of adults with
  doctor-diagnosed arthritis who find it very
  difficult to perform 3 specific joint-related
  activities walk, grasp, and stoop
• Reduce the proportion of adults with
  doctor-diagnosed arthritis who get less than the
  recommended hours of sleep
• Reduce the proportion of adults with
  doctor-diagnosed arthritis who report
  psychological distress.
• QOL in process

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Cost Data

• Project is still underway nothing new to report

Arthritis Impact on Work

• State-specific analysis of 2009 BRFSS data is
  planned for 2010

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Opportunity to describe anxiety/depression for
people with arthritis in your state

• 2010 BRFSS
• SAMHSA funding 11 states to use a 10 question
  anxiety/depression module (AZ, GA, HI, IN, LA,
  ME, MI, NJ, NV, SC, WI)
• Other states may be using the module too
• If your state is already planning to use the
  anxiety/depression module, you can add single
  question arthritis module to 2010 BRFSS
• CDC will analyze data

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Module 17 Anxiety and Depression

• Questions about mood in past 2 weeks
• 1. How many days have you had little interest or
  pleasure in doing things?
• 2. How many days have you felt down, depressed
  or hopeless?
• 3. How many days have you had trouble falling
  asleep or staying asleep or sleeping too much?
• 4. How many days have you felt tired or had
  little energy?
• 5. How many days have you had a poor appetite or
  eaten too much?
• 6. How many days have you felt bad about
  yourself or that you were a failure?
• 7. How many days have you had trouble
  concentrating on things, reading or watching the
  TV?
• 8. How many days have you moved or spoken so
  slowly that other people could have noticed? Or
  the opposite being so fidgety or restless .
• 9. Has a doctor or other healthcare provider
  EVER told you that you have an anxiety disorder
• 10. Has a doctor or other healthcare provider
  EVER told you that you have a depressive disorder

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Next Steps

• If your state is already planning to collect data
  on anxiety/depression and you would like to
  obtain this information for people with arthritis
  in your state
• You need to
• lobby your BRFSS coordinator to add the single
  question arthritis module and
• contact you arthritis project officer and me.

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Questions?
Julie Bolen, PhD, MPH 770-488-2481 jcr2_at_cdc.gov J
ennie Hootman, PhD, MPH 770-488-6038 tzh7_at_cdc.gov